Provider Demographics
NPI:1689697864
Name:AUSTIN, LAURA ALYCE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ALYCE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:571 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6404
Mailing Address - Country:US
Mailing Address - Phone:479-527-0100
Mailing Address - Fax:479-527-0102
Practice Address - Street 1:571 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6404
Practice Address - Country:US
Practice Address - Phone:479-527-0100
Practice Address - Fax:479-527-0102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist